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A black alert is issued when a hospital is “unable to deliver comprehensive care” and “there is increased potential for patient care and safety to be compromised," according to NHS England’s definition.

The crisis triggers a response from the local health system.

Operational Pressures Escalation Levels

OPEL 1: The local health and social care system can meet the needs of patients.

OPEL 2: The system is starting to show signs of pressure. Focused action needed.

OPEL 3: The system is experiencing major pressures. Urgent action needed.

OPEL 4: The pressure continues to worsen and the system cannot provide comprehensive care. Increased risk to patient care and safety. Extensive outside support and intervention needed.

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A spokesman for the NHS trust that runs the RUH said: "We have plans in place to help us manage peaks in demand and capacity at any time of the year.

"Patients can be reassured that it is our priority to maintain high standards of care, safety and experience at all times."

How the OPEL system works

The spokesman explained: "The Opel system is a framework that NHS hospitals and the local health care system use to manage patient demand and direct resources most efficiently.

"The demand, capacity and flow of patients coming into and leaving a hospital is assessed throughout the day by senior staff where a number of factors are used to define the Opel level.

"These factors include the number of patients in our emergency department and A&E, the number of patients expected to be admitted, the waiting times in ED and A&E, and the number of beds available across the trust, in neighbouring hospitals and in the community.

"The Opel level can rise or fall throughout a day through this combination of factors."